Healthcare Provider Details

I. General information

NPI: 1689664617
Provider Name (Legal Business Name): GARY WAYNE PUNDT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N BROADWAY
ROCHESTER MN
55906-3646
US

IV. Provider business mailing address

202 N BROADWAY
ROCHESTER MN
55906-3646
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-6463
  • Fax: 507-288-2192
Mailing address:
  • Phone: 507-288-6463
  • Fax: 507-288-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115189-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: